The Future of Patient X

  • Date 10.18.2020

  • Author Lauren Coughlin

  • Contributors Rich Killeen, Levina Chi, Nick Price, Kalee Holdren, Neda Dahi & Amir Ghorbani

We gathered with our internal healthcare experts to discuss future patient expectations and demands in a post-pandemic world. We focused heavily on patient experience and started by discussing the major benefits of virtual care – primarily telemedicine – and the hurdles that still exist to make it viable as a mainstream service. With virtual care currently complimentary to (not in place of) in-person care, our conversation eventually shifted to the future experience in the physical environment. We focused on the first impression and sequencing upon arrival. Here’s what our team had to say:

Will Virtual Care be a Catalyst for Well Care?

“Going to the doctor can feel like going to the principal’s office,” says Kalee Holdren. “We know something is wrong and we’re waiting for the bad news.” Often, we’re visiting a physician to whom we are a stranger. The lack of personal relationship makes sharing – and receiving – information about our health a highly uncomfortable experience. With its convenience and potential to make visits more efficient, telehealth could bring an opportunity for patients to check in with their physicians more regularly – even when they aren’t sick. More broadly, virtual care could encompass these well visits along with PCP and specialist led apps to help patients track their nutrition, physical activities, and medications. Treating the patient, not the disease has been a long sought ideal in America. Nick Price suggests that, “Telemedicine, by enabling more frequent interactions between patient and provider, could aid in the achievement of a culture of well-being care. By building trusting relationships, telemedicine can make in-person visits more relaxed, supportive, and effective.”

Virtual Care = Accessibility.

Often a gateway for patients seeking treatments for behavioral and mental healthcare, telemedicine has seen a recent surge in these practice areas. Going virtual breaks down the stigma around seeking out mental health services. There is no risk of running into a colleague or a classmate – or a doctor outside of visits. For some, a reduction in patient-therapist intimacy lessens the reluctance to speak openly and honestly. Virtual health also offers accessibility to expert care in non-local regions. Specialists and therapists can provide care globally, allowing patients more choice in their providers. In senior living environments and for homebound patients, virtual care is readily and more frequently available than in-person care. Virtual health, especially telemedicine, brings a convenience and accessibility to health services with which the physical environment simply cannot compete.

Virtual Care, Insurance Coverage, + Transparency <– they don’t get along.

Yet, there are some fairly large hurdles for telemedicine that our team identified both in infrastructure and in confidentiality. As Richard Killeen reminds us, “Telemedicine is currently covered by insurance due to the pandemic, but this is not the norm across the board. Typically, out of pocket patient costs for telemedicine are higher than routine, in-person copays. And physicians have had a lot of trouble collecting reimbursements from the insurance companies.” Additionally, among patients, there is friction between the desired convenience of virtual medicine, accepting the potentially higher costs, and the concerns of personal privacy and data security. At present, access to and between apps and portals is cumbersome and complicated and costs patients precious time. For a virtual care system to be widely adopted, streamlining and simplifying access to information and records is paramount.

The last hurdle we discussed was raised by Levina Chi who brought up a space challenge. Telemedicine still requires real estate infrastructure. She explains that, “Spaces for telemedicine need to be acoustically sound and visually private to meet HIPAA requirements. They also need to have appropriate light levels and strong 5G connectivity to ensure a high quality of care.” Not surprisingly, the quality we’re accustomed to while video chatting with a friend or watching a webinar doesn’t cut it for the American Medical Association.

With these obstacles, we’ll likely see a pickup in physical office visits as time goes on – when virtual isn’t so much a requirement as it is a convenience. In fact, telemedicine visits accounted for just 21% of total encounters in July, down from 69% at the early peak of the public health crisis in April, according to national data from Epic, an electronic health records company. So, how might telemedicine and the pandemic as a whole affect patient experience in the physical healthcare environment? Our team looked at the first impression – the waiting room – and discussed our predictions.

The Waiting Room May Always be a Theoretical Parking Lot.

The reality is…waiting rooms aren’t generating revenue. Nick shares that, “Even prior to the pandemic, our team was looking at ways to increase efficiencies and reduce square footage.” Plus, who really likes waiting? The pandemic driven option to wait for a text while seated in your car may become a permanent solution. A much smaller waiting room is possible if most patients would rather wait elsewhere. Additionally, administrative staff may have the ability to work from home more, further reducing the square footage requirement. Amir Ghorbani recommends that, “Some of the square footage saved by a reduction in waiting room size could be dedicated to more patient rooms, including tele-med spaces.” This would allow for more patients to wait in a private space rather than crowding a shared one which, at least for the short-term, may be a necessity. Neda Dahi proposed an alternate solution that, “There could be a building common area, similar to the shared amenity spaces in a corporate office building or retail environment. Patients could wait here, in a more expansive area, minimizing that dreaded ‘being at the doctor’s office’ feeling”.

The Waiting Room to Quell Anxieties.

Let’s face it. Visiting a healthcare setting is not one of our favorite moments. Medical environments tend to be stressful and, post pandemic, this may be an even more common emotion. The new waiting room should focus on minimizing anxieties and making patients feel comfortable as they wait. Environmental psychology has shown us that this can be achieved in part with material choices – biophilia, for example, and using colors found in nature. The arrangement of the furniture is also a necessary adjustment. Many waiting rooms, with the goal to maximize seating, are overfilled with chairs – often closely facing others or all facing the door where a nurse will pop out to call a name. An arrangement like this generates feelings similar to being in a crowded elevator but with the added stress of being called on next in class. Smaller arrangements that are more diverse and that focus on calming elements – like biophilic materials, artwork, or water features – can make the experience more relaxing. Process is a key step as well. Rich suggests that “Paperwork filled out virtually in advance could minimize time on-site and eliminate the unwelcoming experience of walking up to a desk with a very high counter or administrative staff seated behind a window.”

The Patient Controlled Waiting Room.

A lack of control contributes to the unenjoyable experience of a waiting room, especially if a patient’s only option is to sit and wait. Opportunities for self-check in and being notified that your room is ready via a buzzer (similar to those used in restaurants) begin to offer patients autonomy and flexibility in where and how they wait. The ‘wait’ itself should also be reconsidered to allow patients to spend their time in other ways. Medical offices could take cues from the varied common spaces typical in corporate environments. Patients could wait at a table, in a booth, or in a lounge chair. The furniture – even if traditional waiting room seats are utilized – could offer access to power, similar to an airport, so patients are able to use a laptop or a table surface for work. Kalee reminded us that waiting room efficiency has been a common project driver and advised that more practices consider a coworking or med-share environment. “If a waiting area is shared by four or ten or even more practices, the investment and, in turn, the experience within it may bring more opportunity for variety in the space types available and give patients more choice and control in how and where they wait.”

The Blended Waiting Room.

Another possibility to achieve a more efficient waiting room footprint is to blur the line between patient rooms and the waiting area itself. A positive experience could be achieved by having patients move less and physicians move more. Nick envisions bringing consultation rooms up front and within the waiting area, making them acoustically and visually private. “These spaces could become an extension of the waiting room. Instead of waiting in shared space, a patient would wait in private. They’d stay here to meet with the nurses and doctors and for any required follow up – scheduling, billing, and insurance.”  Areas just outside of or between the consultation rooms could be similar to a foyer or greeting area and offer a short term transition from the entrance to a room. In this scenario the waiting room is essentially replaced entirely with patient rooms – bringing efficiency and simplicity to both the office real estate and the patient experience.

It’s too soon to tell what effect virtual care will have on the physical medical environment. One study by Deloitte – “The Future of Virtual Health”- which interviewed healthcare executives in April of 2020, found that 50% believe that at least a quarter of outpatient, preventative, long-term, and well-being services will move to a virtual platform by 2040. So, while telemedicine may not be storming the castle just yet, it does seem to be an inevitable shift. Paired with new, pandemic driven patient expectations, physicians will need to consider how to plan a future environment – physical or virtual – that gives patients an experience that builds trust, offers safety and comfort, and presents a high level of control and convenience.


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